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I Sapci, M GamalEldin, A Rencuzogullari, H Kessler, TL Hull, CP Delaney, SR Steele, E Gorgun
Cleveland Clinic Foundation

Three-dimensional (3D) visualization technology for laparoscopy has been proposed since the early 1990’s. We hypothesized that 3D laparoscopic visualization will provide surgeons visual advantages over 2D laparoscopy and reduce the overall operating time with comparable perioperative outcomes.

This is a randomized prospective single center trial designed to determine a 10% reduction in mean operating time in patients undergoing laparoscopic total abdominal colectomy with end ileostomy(TAC w EI) with a diagnosis of ulcerative colitis(UC). Patients older than 18 years of age undergoing elective TAC w EI were included in the study. All subjects were randomized into two groups: 3D or 2Dlaparoscopy. Power analysis was based on 80% with 5% significance. Olympus 3D Surgical Imaging System was used for operations that were randomized to 3D. This setup required 3D glasses to be worn bythe operating surgeon and all operating room staff. Three staff surgeons performed the procedures with 2D and 3D laparoscopy. One of three surgeons performed all operations using a single port approach. Surgeon’s subjective evaluation of the visualization system was measured with a standardized survey after completion ofeach surgery. Time to complete each step of the procedure was documented separately. Additional data collected included device deficiencies, serious intra- and post-operative complications.

A total of 53 subjects (26 in 2D group, 27 in 3D group) were included in the final analysis, of which 56% were male with a mean age of 40 and body mass index of 23.5 kg/m . Twenty-five subjects underwent single port laparoscopic surgery. Visual parameters were scored using the scoring system 1-5, 1 being poor and 5 excellent. Overall, 69% of the survey results favored 3D compared to 2D based on the visual evaluation surveys (p=0.014). Mean operative time was 75.3 ± 30.8 minutes for 3D and 82.7 ± 38.6minutes for 2D, p=0.4.Operative times for each step of the procedure were comparable between the groups.Post-operative complications were comparable between the groups (8 vs. 8, p=1). Mean estimated blood losswas 44.8 ± 42.3 ml.

Three-dimensional laparoscopy for total colectomy in ulcerative colitis patients is feasible with significantly better visualization.

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